practical nursing series: pediatric nursing - · pdf file• bronchitis • pneumonia...

Practical Nursing: Pediatric Nursing 2015 Teacher Edition: HO1302 Student Workbook: HO3302 Test Bank CD: HO8302 To order, call 800.654.4502 or visit www.okcimc.com

Practical Nursing Series: Pediatric Nursing

This free sample provided by CIMC www.okcimc.com 800.654.4502

Pediatric Nursing builds on the concepts and skills for previous courses. This full-color curriculum focuses on nursing for the pediatric patient including: growth and development; health promotion; care of the hospitalized pediatric patient; care of the infant, toddler, preschool child, school-age child, and adolescent. Pediatric Nursing is designed to teach the nursing student focused nursing skills and the ability to apply their knowledge to prepare for the NCLEX-PN. A test bank CD is also available. Modules include: Growth and Development of the Pediatric Patient Health Promotion of the Pediatric Patient Care of the Infant Care of the Toddler Care of the Preschool Child Care of the School-Age Child Care of the Adolescent Care of the Hospitalized Pediatric Patient

Copyright 2015 Oklahoma Department of Career and Technology Education

Toddlers have limited judgment skills yet fierce determination for autonomy and demand attention. Toddlers, who tend to

be egocentric and ritualistic, are often upset with changes in routine and control. The nurse must be

ready to care for toddlers with special knowledge about their developmental characteristics while us-ing the nursing process for diseases and disorders, which occur commonly in this developmental period.

M O D U L E 4C A R E O F T H E T O D D L E R

Free Sample Provided by CIMC 800.654.4502

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C I M C • P E D I A T R I C N U R S I N G2

L E A R N I N G O B J E C T I V E S

1. Discuss the special nursing considerations for a child with autism.

2. Identify care for a toddler who has experienced an accidental poisoning.

3. Relate diagnostic tests and surgical procedures to the nursing care for the toddler with common diseases/disorders.

4. Evaluate pharmacological effects of medications used to treat the toddler with common diseases/disorders.

5. Discuss the nursing care for a toddler with common diseases/disorders.

6. Describe teaching needs for a family with a toddler with common diseases/disorders.

Common Diseases and Disorders

•Wilms’Tumor •Pinworms •Deafness •Croup •Epiglottitis •Bronchitis

•Pneumonia •Fractures •Dislocations •CerebralPalsy •HeadInjuries

2 C I M C • P E D I A T R I C N U R S I N G

Review the Learning Objectives with the students. Look ahead

to the Learning Activities in this module and plan to introduce them.

i


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M O D U L E 4 • C A R E O F T H E T O D D L E R • T E A C H E R E D I T I O N 3

Additional Learning Activity

In small groups, have students identify home or inpatient interventions for the following scenario and share their findings with the class.

• An11-year-oldchildisdiagnosedwithautism.Thechild’sfatherhasabandonedthemother,andthemotherisbecom-ingoverwhelmedwiththechild’scare.Thechildisveryresistanttochange,andtheabsenceofhisfatherinhisdailyrituals has resulted in repeated, violent tantrums. He is under sensitive to pain and does not appear to have a concept of danger to himself or others. Finally, he does not like to be touched.

w w wlearninglink

AutismFactSheet–NationalInstituteofNeurologicalDisorderswww.ninds.nih.gov/disorders/autism/detail_autism.htm

AutismSpeakswww.autismspeaks.org/

Class Discussions

• Discussthecharacteristicsof autism and the long-term prognosis for chil-dren diagnosed with this disorder.

• Discusstheroleofthenurse in providing access to resources to assist the parents of the child with autism.

L E A R N I N G O B J E C T I V E

Object i ve Discuss the special nursing considerations for a child with autism.

A common disorder seen in toddlers is autism. This is a developmental disorder which has several different signs and symptoms. These specific types of autism are referred to as autism spectrum disorders (ASDs).

A toddler with autism will exhibit:

• Impairedsocialinteraction

• Inabilitytocommunicatebothverballyandnon-verbally

• Repetitiveorunusualactivities

• Unusualinterests

The latest statistic is showing that males are diag-nosed four times more often than females, and about three to six children out of every 1000 have symp-toms of autism.

The first signs of autism may be the unresponsiveness to eye contact and lack of interaction with parents. The child appears withdrawn and social skills are often late in developing or will not develop at all. Often the child will have repetitive movements such as rocking and twirling. The child will not accept comforting or cuddling, which may be due to an ab-normal sensitivity to sound, touch or other stimuli.

The child appears different than other children, not in physical appearance, but in social interaction.

Since there is no cure for this condition, nursing care and medical treatment have long range implications.

The child’s condition is often treated by supporting the symptoms such as administration of antidepres-sant medication to deal with anxiety, depression or obsessive-compulsive disorders. Other medications used for attention deficit disorders are used to de-crease hyperactivity and impulsivity.

Nursing care must be directed toward support of the child and family in living with the disorder and the many associated symptoms.

M O D U L E 4 • C A R E O F T H E T O D D L E R • S T U D E N T E D I T I O N 3


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www.ninds.nih.gov/disorders/autism/detail_autism.htm

www.ninds.nih.gov/disorders/autism/detail_autism.htm

www.autismspeaks.org/what


Learning Activity Answers

Answerswillvary.


L E A R N I N G A C T I V I T Y 1

N A M E

Introduction

Observations can play a vital role in how the nurse cares for the patient with autism. The nurse must be able to care for this type of patient with caring and understanding.

Activity

Visit the Autism Speaks website (www.autismspeaks.org/) and view the video clips of behaviors of children with autism.

1. During the video, list all of the signs of autism that are noticeable. Next to each sign, identify what would be a normal characteristic for a child of similar age.

2. From a nursing care plan book, list the nursing diagnosis that would be appropriate for this child.

3. Then list the nursing interventions that the nurse would suggest be added to a care plan for this child, should the child get a severe sinus infection.

4. What activities should the nurse do to support the family during the time the child is experiencing this infection?

Application

Share your results and compare with a classmate or the facilitator. Discuss why their results are different from yours. What changes would you make to your identified results and why?


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Class Discussions

• Discusstheroleofthenurse in treating the child with acetaminophen poi-soning.

• Discusstheroleofthenurse in educating parents about the delivery of acet-aminophen to their child.

• Discussthesignsandsymptoms of lead poison-ing and the treatment provided for children affected.

• Discussthestepsthatcanbe taken to ensure that the child is not exposed to lead, and the role of the nurse in educating parents of small children about the dangers associated with lead exposure.

Classroom Activity

Divide the class into four groups.Assigneachgroupone of the stages of acetamin-ophen poisoning, and have the group identify treatment and nursing interventions for its assigned stage. Then have each group share its results with the class.


L E A R N I N G O B J E C T I V E

Object i ve Identifycareforatoddlerwhohas experienced an accidental poisoning.

I D E N T I F I C A T I O N O F P O I S O N I N G

Accidental poisonings occur frequently in toddlers because of their natural curiosity and exploration. Lacking the capacity to appreciate danger or hazards, they may eat or drink anything that is near which may include toxic substances. More than 90% of poison-ings occur in the home. Frequently ingested substanc-es include medications, cosmetic and personal care products, plants and cleaning products.

Parents and caregivers must be alert to signs of poison-ing. The child can be very quiet or crying loudly after ingestingapoisonoussubstance.Iftheamountoftox-ins is small the child may not show signs of swallowing a poison. Caution parents and caregivers to always do a walk through of a home, if visiting, and store chemi-cals out of reach of toddlers. Signs and symptoms of poisoning will manifest according to the ingested toxin. Common signs and symptoms may be the only indicator of a poisoning. The nurse must be alert to these signs in order to care for the patient properly. Rememberthatthetoxinmaybeunknown.

Ineverycaseofsuspectedoractualingestionofaninjurious agent, caregivers and nurses must be directed to call the Poison Control Center (PCC) as soon as ingestion is suspected and before they initiate any intervention. Home remedies may waste valuable time getting the child proper care or even worsen injuries.

The universal phone number for PCC is 1-800-222-1222. This center will direct parents on the correct action to take regarding the specific substance that the child has ingested. The nurse should tell the parents/caregiver to post this or the local PCC phone number nearorinthememoryoftheirtelephones.Incaseof emergency when the PCC phone number is not available, parents can easily be reminded to call 911; emergency operators can easily connect the caller to the PCC.

The PCC will ask for the following information:

• Caller’snameandphonenumber

• Thechild’sname,age,andweight

• Anymedicalconditionsthechildhas

• Anymedicinethechildistaking

• Thenameoftheitemthechildswallowed

• Thetimethechildswallowedthepoison,orwhen the child was found, and an estimate of the amount swallowed

The amount of certain toxic substances can be more dangerous than others. Teach parents and caregivers that even a small amount of some substance can be life threatening. Acetaminophen is the most common drug that children have access to and ingest.

Usingthisinformation,theexpertadvisestheparentor caregiver what action should be taken immedi-ately and if the child should be seen by a health care provider.Ifthechildisunconscious,havingproblemsbreathing or having seizures, the child should be seen immediately by emergency personnel.

D i d You Know?

The American Academy of Pediatrics (www.aap.org) provides many useful tips for families regarding home safety and prevention of poisoning.


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Additional Learning Activity

Divide the class into groups, and have them discuss the common causes of lead poisoning in children, including environmental exposure. Have each group develop a list of methods to prevent lead poisoning, and then discuss these lists asaclass.Next,havestudentpairs take turns role-playing a nurse-parent interaction in which a nurse is educating a parent about preventing lead poisoning.

Additional Critical Thinking Question

Accidentsaretheleadingcauseofdeathinchildren.Whataresomeofthecharacteristicsoftoddlersthatputthematincreased risk for accidents?

Answer:Toddlers have a new sense of independence, and they want to try new things. By nature, they are very curious and investi-gate by touching and tasting, which puts them at greater risk for burns, bites, and poisoning. Their increased mobility also puts them at greater risk for injuries due to falls or running into dangerous areas. Toddlers lack an understanding of danger. Combined with their curiosity and new mobility, this often leads them into dangerous situations.


Most ingestion of poisons is managed at home. PCC can provide instructions to minimize side effects. However, families often experience an emotional crisis when a child is accidentally poisoned. Parents may feel grief, guilt and responsibility for the child’s inju-ries and resulting treatments. During acute care, the parents need support without accusations or inference of negligence. Because of their anxiety for their child and emotional crisis, interventions to prevent poison-ing recurrence are inappropriate in the emergency phase of treatment. The insightful and sensitive nurse and other health care providers can most effectively promote safety measures once the child is recovering or close to discharge. Prevention of accidental poison-ings requires significant safety measures and supervi-sion of young children in the home.

Patient Care for the Poisoned ToddlerDisorder Structure Affected Physical Findings Nursing Care

Accidental Poisoning

Depends on toxin ingested •Lungs,mouth

throat•Gastrointestinal

system•Nervoussystem•Cardiovascular

system•Skin

•Burninmouthandthroat

•Edemaaroundmouthand throat

•Nausea/vomiting•Signsofshock•Anxietyandagitation•Sweating•Pallor•Confusion•Drowsiness•Respiratorydistress

•Assessairway,breathingandconsciousness

•Keepchildinside-lyingposi-tion to prevent aspiration

•Determinetoxinifpossible•Callpoisoncontrolcenteror

follow facility policy•FollowdirectionfromPCC•Monitorvitalsigns,noting

changes or abnormalities•Administeroxygenasordered•Giveactivatedcharcoalas

ordered•Assessfor: ▶ Diaphoresis ▶ Anxiety ▶ Changes or worsening of

symptoms•Teachparentorcaregiver: ▶ Needs of the child at home ▶ Poisoning prevention

IMPORTANT FACT!The use of Ipecac is no longer an approved treatment of poison due to the prolonged vomiting that may occur. Encourage parents and caregivers to dispose of any that may still be in their homes.


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Classroom Activity

Divide the students into small groups.Assigneachgroupadisorder. Have the group de-velop a parent teaching poster about the disorder.

Additional Learning Activities

• Assigneachstudentadisorder. Have the stu-dent write a paper in APAformatandpresentaPowerPointpresenta-tion to the class regarding pathophysiology, signs and symptoms, treatment and nursing care.

• Dividetheclassintosmallgroups, and assign each group one of the common disorders of the toddler. Have the groups research the disorders, including signs and symptoms, treat-ments, and nursing inter-ventions. Have each group present its findings to the class.



Object i ve Discuss the nursing care for toddlers with common diseases/disorders.

Object i ve Describe teaching needs for a family with a toddler with common diseases/disorders.

C O M M O N D I S E A S E S A N D D I S O R D E R S O F T H E T O D D L E R

Common diseases and disorders of toddlers vary from life-altering disorders to disorders that cause tempo-rary alterations in health such as pinworms.

Common Diseases and Disorders of the ToddlerDisorder Structure Affected Physical Findings Nursing Care

Pinworms (Enterobiasis)

•Colon •Severeitchingespe-cially around anus

•Irritability•Inabilitytosleepwell•Inattentive

•Teachparentorcaregiver: ▶ How to perform tape test ▶ To repeat tape test for

several days ▶ To wash all clothes and

linens in hot waterDeafness •Externalorinternal

structures of the ear•Inabilitytohear •Teachparentorcaregiver:

▶ About speech develop-ment

▶ About the importance of learning sign language

Obtain a piece of tape and wrap it to make a narrow wedge of sticky tape by wrapping tape around itself with sticky side out. Place this wedge of tape near the patient’s anus overnight. The pin worms will become lodged on the tape. Once the specimen is collected, place it in a glass jar or plastic bag, loosely. Tell the patient’s family to bring it to the clinic or lab.

Ta p e Te s t f o r P i n w o r m s


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Class Discussions

• DiscussthesignsandsymptomsofWilm’stumor and the diag-nostic process used to determine the origin and extent of the tumor.

• Discussthewaysinwhich nursing education can help parents and patient understand what to expect as the treat-mentofWilm’stumorproceeds.

Classroom Activity

Divide the class into two groups.Assignonegrouppreoperative care and the other postoperative care of achildwithWilm’stumor.Have each group list nursing interventions for its as-signedstage.Next,inaclassdiscussion, have the students compare their interventions and discuss their rationale.


Disorder Structure Affected Physical Findings Nursing CareWilms’ Tumor •KidneyRenal

System•Abdominalswellingormass: ▶ Firm ▶ Nontender ▶ Confined to one

side•Hematuria•Fatigueandmalaise•Hypertension•Weightloss•Fever•Withmetastasis: ▶ Dyspnea ▶ Cough ▶ Shortness of

breath ▶ Chest pain

Pre Procedure:•Consents•Prepasordered•Donotpalpatemass

Monitor:•Vitalsigns•Gastrointestinalactivity ▶ Bowel sounds and move-

ment•Abdominaldistention,pain•Vomiting•Urineoutput•Signsofinfection•TCBD

Teach parent or caregiver:•Abouttheprocedure•Aboutpost-operativeradia-

tion or chemotherapy


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Class Discussions

• Discussthesignsandsymptoms of croup and the specific indicators that suggest the child should be seen by a medical pro-fessional.

• Discussthecarerequiredfor a 2-year-old child with croup. Consider the role of the nurse in guiding the care of the child in both home and hospital set-tings.

Classroom Activity

Have students work in pairs to develop a teaching guide for parents to use when their childof1,2,or3yearsofage has croup. Have students include signs and symptoms, treatment methods to use at home, signs and symptoms of respiratory distress, and guid-ance on when to seek medical attention.Next,havestudentstake turns role-playing a nurse-parent interaction in which the nurse educates the parent on caring for the child with croup.


Respiratory Conditions for the Toddler

Respiratoryconditionsfortoddlersarequitescaryfor the parents. The child often sounds extremely bad, especially when they have croup or bronchitis. The child can experience respiratory distress rapidly and will need emergency care. Other respiratory con-ditions, such as bronchitis, sound bad, but are mild and often resolve in 2-3 days.

Respiratory Conditions for the ToddlerDisorder Structure Affected Physical Findings Nursing Care

Croup •Larynx•Upperairway•Trachea•Bronchi

•Loudbarkingcough•Respiratorydistress•Swellingofthelarynx

blocking air flow•Temperatureelevation

•Monitorforrespiratorydis-tress, fever and irritability

•Teachparentorcaregivertoavoid the flu and to get flu vaccines for children

Epiglottitis •Epiglottis •Sorethroat•Painonswallowing•Elevatedtemperature•Strugglestogetair

into lungs and finds sitting more comfort-able

•Unabletorest•Cranky•Drooling

•Life-threateningconditionthatdemands immediate action

•Monitorrespirationrate•Readpulseoximetryfrequently•Allowchildtofindposition

of comfort•Monitorvitalsigns.Ifpulse

and respiration are elevated, report at once

•Increasedrestlessnessmaybesign of distress. Take action quickly

•AdministeroxygenasdirectedBronchitis •Inflammationof

large airways (tra-chea and bronchi)

•Dryhackingcough•Symptomsgetworseat

night•Coughthatdoesn’t

result in sputum

•Administeranalgesics,anti-pyretics, and humidity

•Haveaparentorcaregivertake child in bathroom and run shower to fill room with humidity

•Bedrestbetweencoughingspells•Givecoughmedicationsas

orderedPneumonia •Oneormorelobes

of lungs•Beginsinbronchi-

oles•Alveolarwalls

•Fever•Respiratorydistress•Rapidrespirations•Chestpain•Sternalretraction•Cyanosis•Cranky•Lackofappetite

•Givemedicationsasordered•Encouragefluidsandfoods•Monitoroxygensaturation,

vital signs, pain level and respiratory rates

•Placeinisolationaccordingtohospital policies, as indicated


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w w wlearninglink

KidsHealth.org–Typeindisorder in the search sectionhttp://kidshealth.org/

Classroom Activity

Have students call out char-acteristics of adult bones and characteristics of chil-dren’sbones,andlistthemintwocolumns.Next,insmall groups, have students discuss the distinctions be-tweenadults’andchildren’sbones and how treatment and nursing interventions for a toddler with a bone fracture would differ from that for an adult.

Class Discussions

• Discusscompartmentsyndromeandtheroleofthenurseinidentifyingsignsthatsuggestneurovascularimpairmentasaconsequenceoffractures.

• Discusstheprocesscarriedouttocheckthetractiondeviceandensureitsproperdeployment.


Musculoskeletal Disorders of the Toddler

A child with musculoskeletal disorders presents unique issues for the parent and nursing personnel. Since children are highly mobile, conditions that limit this mobility can have profound effects for children. Not only does the child suffer from the disease process, but they also suffer from the effects of immobility. This immobility causes physical and psychologicalcomplicationsforthepatient.Remem-ber that the child and parent will need additional support to counter the effects of lack of movement.

Musculoskeletal Disorders of the ToddlerDisorder Structure Affected Physical Findings Nursing Care

Fractures

Dislocations

•Bones-broken•Articulationof

bones – dislocated

•Pain•Swelling•Deformity

Rest,applyiceandelevateaf-fected extremity if allowed

Routinecareforapatientwithimmobility:•Preventskinbreakdown•Treatconstipation•Monitorrespiratoryrates•Promotehealthyeating•Provideage-appropriateplay•Givemedicationasordered,

especially pain medications

Monitor the five P’s:•Pain,pulses,pallor,paresthe-

sia, paralysis

Provide cast care or traction care

Teach parent or caregiver: •Aboutcareofthecast•Theeffectsofimmobility•Howtomonitorforpsycho-

logical symptomsCerebral palsy •Motordisorder

•Sensation•Perception•Communication•Cognition•Behavior

•Spasticmovements•Slowtwistingmove-

ments•Rapidrepetitive

movements•Uncoordinated•Physicaldeformities•Slurredspeech•Nystagmus•Visualdeficits•Hearingimpairment•Seizures

•Provideoptimumlevelofwellness

•Increasemobility•Maintainpropernutrition•Preventcontractures•Preventinjury•Controlpain•Promotecomfort•Promotesafety•Promoteself-care


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KidsHealth.org

http://kidshealth.org

w w wlearninglink w w wlearning

link


w w wlearninglink

LabTestingOnline–Typeintest in the search sectionhttp://labtestsonline.org/


Disorder Structure Affected Physical Findings Nursing CareHeadInjury

Concussion

EpiduralHemor-rhage (bleeding between dura mater and cranium

Subdural hemor-rhage- venous bleed-ing around the brain

•Brain•Skull

•Lossofconsciousness•Dizziness•Confusion•Increaseintracranial

pressure(ICP)•Slurredspeech•Blurredvision•Nauseaandvomiting•Severeheadache•Unequalpupilsize•Irritability•Seizures•Paralysis

Monitor:•SignsofICP•Vitalsigns•Neurologicchecks•Drainagefromnoseorears•Abnormalposturing

•Teachparentorcaregivertoawaken a sleeping child at regular intervals

Musculoskeletal Disorders of the Toddler Continued


Object i ve Relatediagnostictestsandsurgicalprocedures to the nursing care for the toddler with common diseases/disorders.

Object i ve Evaluatepharmacologicaleffectsof medications used to treat the toddler with common diseases/disorders.

D I A G N O S T I C T E S T S A N D S U R G I C A L P R O C E D U R E S F O R T H E T O D D L E R

Many of the diagnostic tests and surgical procedures for adult patients are also done for the toddler. Considerations to age-appropriate care must be part of the nurse’s role when providing support for the toddler having this type of medical care.


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http://labtestsonline.org



Diagnostic Tests and Surgical Procedures for the ToddlerTest Purpose Procedure Nursing Care

Throat culture •Identifymicroor-ganism

•Usesterileswabtotouchthe posterior wall of the throat

•Putswabintoappropriatecontainer according to facil-ity policy

•Labelspecimenandtrans-port to lab

•Preparepatientbyex-plaining that a specimen is needed to find out why they are sick

•Enlistparenthelpifneeded

•Demonstratehowtheprocedure will be done and allow them to be-come familiar with the swabs and equipment

•Encouragethepatienttobe still

•Givemedicationsasordered to promote opti-mum testing

•Allowparentorcaregiverto hold child if needed

Blood cultures •Obtainthroughvenipunc-ture venous specimen

•Removeneedleusedtodrawblood and replace with clean needle

•Placebloodspecimenintoculture bottles

•Labelculturebottle•Gentlymixandtransportto

lab according to policyArterial blood gases

•Determinebloodgases level

•Preppatientandparentbyexplaining procedure

•Assistlabpersonnelasneeded

•Applypressuretopuncturesite

Laryngoscopy and bronchoscopy

•Visualizebronchiand branches

•Obtaintissueorfluid from lung

•Removeforeignbody obstruction

Patient receives topical anes-thesia

Scope is inserted into the tra-chea and into the bronchi and bronchioles•Biopsyspecimensand

washings are taken and sent to lab

Pre Procedure•PatientNPO,priorto

exam•Requiressedation

Post Procedure•Observeforhemorrhage•Observefordifficulty

breathing

Teach parent or caregiver:•Patientcannoteator

drink for 2 hours•Reporthighfever•Usesalinegarglesorloz-

enges if throat is sore

Electroencepha-lography(EEG)

•Determinebrainactivity

•Explaintheprocedure•Assurethepatientandfam-

ily that the test is painless•AssisttheEEGtechnician

as needed•Helpcleanpastefromhair

after procedure


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Test Purpose Procedure Nursing CareCT Scan •Diagnosingtu-

mors, nodules, he-matomas, lesions, cysts, abscesses, pleural effusion and enlarged lymph nodes, abnormal cardiac tissue

•CTscaniscross-sectionalvisualization of tissues which allows for identifica-tion of slight variations in tissue thickness

•Maybewithorwithoutcontrast (assess for allergies)

•Moreenhancedthanx-rays•Spiralorhelicalversion

produces thinner slices and data more enhanced

Pre Procedure•Explaintheprocedure•Obtainconsent•Assessforallergies•Instructparentor

caregiver that pateint is to be NPO according to hospital policies

Post Procedure•Encouragefluidstoassist

in dye excretion•Answerquestionsabout

how they will find out about the results

MRI •Providesbettercontrast between normal and patho-logic tissues

•Reducesboneartifacts

•Computerizedimageswhich assist in identifica-tion of subtle changes in tissue structure

•Nursingresponsibilityprior to exam is to check for allergies in patient

•Removeallmetalduringthe procedure due to the magnet used for captur-ing the images

•Assessifpatienthasanyimplants or a pacemaker

Lung Scan/Venti-lation-perfusion

•Toidentifyareasof ventilation and perfusion to lungs

•IVinjectionofradioisotopegiven to patient

•Gammaraydetectorispassed over the patient and records uptake of radioiso-tope

•Patientisplacedinvariouspositions to visualize differ-ent areas of the body

Pre Procedure•Obtainconsent•Explaintheprocedure•Assurethatexposureto

large amounts of radioac-tivity will not occur

•Administer10dropsofLugol’s solution sev-eral hours before test as blocking agent against iodine 131

•Fastingisnotneeded•Removejewelryaround

chest area

Post Procedure•ApplypressuretoIVsite•Noradiationprecautions

are needed

Diagnostic Tests and Surgical Procedures for the Toddler Continued


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Test Purpose Procedure Nursing CareX-Ray Visualization of

fracture or abnormal soft tissue

•Affectedareaisplacedun-der the X-ray machine and an image is captured

•Explaintheprocedure•Allowchildtoseeequip-

ment•Exhibitpatienceaschild

is allowed to position on the exam table

•Allowparentorcaregiverpresent if needed while shielding parent from x-ray beams

•Aftertest,assistchildandparent or caregiver back to exam room

Diagnostic Tests and Surgical Procedures for the Toddler Continued


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w w wlearninglink

MedicineNet–Typeindis-ease in the search sectionwww.medicinenet.com MedlinePlus–Typeindisor-der in the search section www.nlm.nih.gov/medlin-eplus/ DrugsOnline–Typeinmedi-cation in the search sectionwww.drugs.com/


P H A R M A C O L O G I C A L C O N S I D E R A T I O N S F O R T H E T O D D L E R

Toddlers often have to take medications before diagnostic tests and procedures. They may also have to take medications for medical conditions. Special considerations for the toddler must be taken to administer medications safely. Dosage calculations must be done carefully and rechecked before admin-istering the drug. Children are more susceptible to sideeffectsandadversereactionsthanadults.Use

caution when giving toddlers medications. The fol-lowing drugs are used for conditions in this module in addition to drugs for pain relief and reduction of complications of immobility.

Medications used for the ToddlerCategory and

Examples Uses Actions Side Effects Nursing Considerations

Bronchodilators•AlbuterolSulfate•Salmeterol•Metaproterenol

Sulfate

Prevents broncho-spasm that occurs with asthma

Causes bron-chodilation by stimulating beta-adrenergic receptors

Work by pre-venting media-tor release from mast cells

•Drymouth•Muscletremors•Tachycardia•Hypertensionor

hypotension•Nervousness•Insomnia

•Monitorheartrateand blood pressure

•Increasefluidintake

•Nottobeusedwith cardiac disease

Antihistamines•Clemastine•Diphenhy-

dramine•Loratadine

Relievessymptomsof allergic response

Blocks hista-mine receptors

•Drymouth•Drowsiness

•Informparentsthatchild may become drowsy

Anticholinergics•Ipratropium•Bromide

Reducesrhinorrhea Causes bron-chodilation by stimulating beta-adrenergic receptors and blocking acetyl-choline

•Anxiety•Dizziness•Headache•Drymouth•Nausea•Vomiting•Cough

•Donotmixwithcromolyn sodium

•Limitcaffeineconsumption

Decongestants•Pseudoephed-

rine•Phenylephrine•Azelastine

Promotes vasocon-striction

Reducesnasaledema and rhinor-rhea

Causes vasocon-striction of nasal membranes

•Anxiety•Dizziness•Tremors•Headache•Insomnia•Hypertension

•Takeearlyindaytoavoid sleeplessness

•Avoidtakingwithhypertension, dia-betes, glaucoma


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www.medicinenet.com

www.nlm.nih.gov/medlineplus

www.nlm.nih.gov/medlineplus

www.drugs.com



Category and Examples Uses Actions Side Effects Nursing

ConsiderationsAntiinflammatories•Hydrocortisone•Methylpredni-

solone•Beclomethasone

Decrease edema in bronchial airway

Decrease mucus production

Decreases in edema in airways and a decrease in production of mucous, leading to decrease in inflammation

•Headache•Sorethroat•Drymouth•Cough

•Maymasksignsofinfection

•Monitorforedemaand weight gain

Mebendazole (Vermox)

Treatment for Pin worms

Inhibitsglucoseuptake of the pinworm, caus-ing it to die

•Dizziness•Tinnitus•Abdominalpain•Increaseliver

enzymes

•Assessstoolsforpresence of pin worms

•Teachparentorcaregiver:

▶ Signs of infec-tion

▶ Wash clothing and linens in hot water

▶ Wash hands af-ter every bowel movement

▶Giveaftermeals to avoid GIsymptoms

•Dantrolenesodium (Dantrolene)

•Baclofen(Lioresol)

•Diazepam(Valium)

•Botulinumtoxin(Botox)

•Intrathecalbaclofen

Improvenerveandmuscle contractions

Interfereswithintracellular function caus-ing a slowing of muscle spasms

•Hypotonia•Sleepiness•Seizures•Nauseaand

vomiting•Headache

•MonitorI&O•Checkforurinary

retention•Monitorliverfunc-

tions•Monitorfor: ▶ Weakness ▶ Depression ▶ Dizziness ▶ Drowsiness ▶ Pain in abdomen•Administeredusing

pump that is surgi-cally implanted into mid abdomen

•Monitorforsideeffects

Medications used for the Toddler Continued


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Category and Examples Uses Actions Side Effects Nursing

ConsiderationsAntineoplastics •ActinomycinD

(dactinomycin)•Vincrinistine•Doxorubicin•Etoposide•Cyclophosph-

amide along with mesna

Treatment of Wilms’ tumor

Arrest cell production and block cancer cell growth

•Nausea•Vomiting•Anorexia•Hairloss•Lowwhiteblood

cell counts

Radiationsideef-fects include •Nausea•Fatigue•Skinirritation•Diarrhea

Monitor:•Bloodstudyabnor-

malities•Respiratorystatus

Assess:•Nutritionalstatus•Neurologicalstatus

Teach parent or care-giver:•Avoidaspirinor

NSAIDSbecauseof bleeding risk

•Watchforsignsofanemia

•Childmaylosehair•Increasefluids

Medications used for the Toddler Continued


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K E Y S U M M A R Y

• A common disorder seen in toddlers is autism. This is a developmental disorder which has several different signs and symptoms. These specific types of autism are referred to as autism spectrum disorders (ASDs). A toddler with autism will exhibit:

•Impairedsocialinteraction •Inabilitytocommunicatebothverballyandnonverbally •Repetitiveorunusualactivities •Unusualinterests

• Accidental poisonings occur frequently in toddlers because of their natural curiosity and exploration. Lacking the capacity to appreciate danger or hazards, they may eat or drink anything that is near which may include toxic substances. More than 90% of poisonings occur in the home; frequently ingested substances include medications, cosmetic and personal care products, plants and cleaning products.

• Common diseases and disorders of children vary from life-altering disorders to disorders that cause temporary alterations in health such as pinworms.

• Respiratoryconditionsfortoddlersarefrighteningfortheparents.Thechildoftenhassignificant audible respiratory symptoms when they have croup or bronchitis. The child can experience respiratory distress rapidly and will need emergency care.

• A child with musculoskeletal disorders presents unique issues for the parent and nursing personnel. Since children are highly mobile, conditions that limit this mobility can have profound effects for children. Not only does the child suffer from the disease process, but also from the effects of immobility.

• Many of the diagnostic tests and surgical procedures for adult patients are also done for the toddler. Considerations for age-appropriate care must be part of the nurse’s role when providing support for the toddler requiring medical care.

• Similar to diagnostic tests and procedures, toddlers take medications for conditions. Special considerations for the toddler must be taken to administer medications safely. Dosage calculations must be done carefully and rechecked before administering the drug.


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G L O S S A R Y

Autism: A developmental disorder, often identified in early childhood, characterized by impaired social interaction, problems with verbal and nonverbal communication,

and unusual, repetitive, or severely limited activities and interests.

Concussion: A common type of traumatic brain injury.

Dislocation: The separation of two bones where they meet at a joint.

Fracture: A break in a bone.

Pneumonia: A respiratory illness caused by inflammation of the alveoli and terminal airspaces in response to invasion by an infectious agent introduced into the lungs.

Wilms’ Tumor: A rare kidney cancer that primarily affects children. Also known as nephroblastoma, it is the most common malignant tumor of the kidneys in

children.


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R E S O U R C E B I B L I O G R A P H Y

Publications

American Academy of Pediatrics (2007). What are autism spectrum disorders and what are the symptoms?

American Academy of Pediatrics (2007). What do I do if my child has been poisoned?

American Academy of Pediatrics Committee on Quality Improvement (1999). The Management of Minor Closed Head Injury in Children. Pediatrics 104 (6), 1407-1415.

American Cancer Society (2008). How is Wilms Tumor diagnosed?

Cooley, W.C and AAP Committee on Children with Disabilities (2004). Providing a primary care medical home for children and youth with cerebral palsy. Pediatrics 114:4, 1106-11113.

Bowden, V.R. and Greenberg, C.S. (2003). Pediatric Nursing Procedures. Philadelphia: Lippincott Williams & Wilkins.

Hockenberry, M., Wilson, D. & Winkelstein, M.L. (2005). Wong’s Essentials of Pediatric Nursing (7th ed.). St Louis: Elsevier.

Nursing Focus. Stillwater, OK: Oklahoma Department of Career and Technology Education, Curriculum and Instructional Materials Center, 2002.

Online

American Academy of Pediatrics (AAP) Poison Preventionwww.aap.org/healthtopics/safety.cfm

National Center of Medical Home Initiatives for Children with Special Needswww.medicalhomeinfo.org/how/care_delivery/cyshcn.aspx

American Cancer Society (ACS)http://cancer.org

American Speech-Language-Hearing Association (ASHA)www.asha.org/default.htm

Autism Information Centerwww.cdc.gov/ncbddd/autism

Autism Society of Americawww.autism-society.org/



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Autism Speakswww.autismspeaks.org/

March of Dimeswww.marchofdimes.com/

United Cerebral Palsy (UCP)www.ucp.org

Center for Patient Information and Resourceswww.parentcenterhub.org

Chemotherapywww.nlm.nih.gov/medlineplus/tutorials/chemotherapyintroduction/htm/index.htm

CT Scanwww.nlm.nih.gov/medlineplus/tutorials/ctscan/htm/_no_50_no_0.htm

Cerebral Palsy www.nlm.nih.gov/medlineplus/tutorials/cerebralpalsy/htm/_no_50_no_0.htm

Fractures and Sprainswww.nlm.nih.gov/medlineplus/tutorials/fracturesandsprains/htm/index.htm

MRIwww.nlm.nih.gov/medlineplus/tutorials/mri/htm/index.htm

Newborn Screeningwww.nlm.nih.gov/medlineplus/tutorials/newbornscreening/htm/_no_50_no_0.htm

Pneumoniawww.nlm.nih.gov/medlineplus/tutorials/pneumonia/htm/index.htm


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N O T E S



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